clinical parameters furcationrecession mobility this presentation will probably involve audience...
TRANSCRIPT
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Clinical Parameters
Furcation Recession
Mobility
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Learning Outcomes
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Furcations: Clinical ConsiderationsMay or may not be clinically exposedBifurcation: 2 rooted toothTrifurcation: 3 rooted toothRadiographs may aid diagnosisSuspect furcation involvement when
pockets measure 5-6 mm+Increased risk for root caries, root
resorption, recession sensitivity, pulp involvement, abscess formation
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Furcations
Extension of bone loss between roots of teeth
Teeth with furcation involvement are high risk for continued attachment loss
Detection of furcation faciliated by using a specially designed furcation probe
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Probing Furcations
No. 2 Naber’s furcation probe & a narrow Michigan O periodontal probe
Move probe towards location of the furcation & curve into furcation area
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Probing Furcations
Access to furcations:– Mesial surface max. molars:
• Best to approach from palatal direction b/c mesial furcation is palatal to midpoint of mesial surface
– Distal surface of max. molars• Located more towards midline• Detected from buccal or palatal approach
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Probing Furcations
Most common site: mand. First molar
Least common site: max. first bicuspid
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Furcations: Classification, Characteristics, TreatmentFurcation Characteristics Treatment Options
Grade I Initial involvement, may penetrate area up to 3 mmSlight bone lossSuprabony pocketsNo radiographic changes
Perio debridementOdontoplasty
Grade II Bone lost on one or more aspects, > 3 mm but not through & throughHorizontal depth variesVertical bone loss possiblePossible radiographic visibility
Perio debridementFlap with odontoplasty & osteoplastyGuided tissue regeneration (more success with mand. Molars)Root resection
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Furcations: Classification, Characteristics, TreatmentFurcation Characteristics Treatment Options
Grade III Interradicular bone absentAccess on fa/li blocked by gingiva“Through & through “Radiographically visible
Perio debridementFlap procedureOdontoplastyRoot resectionhemisection
Grade IV Interradicular bone absentClinically visible“Through & through”Radiographically visible
DebridementFlap surgery
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Furcations
Slimline access Radiographic assessment
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Root Resection & Hemisection Root resection:
– Performed on vital or endodontically treated teeth
Hemisection:– Splitting of two rooted
tooth into two parts
– Following sectioning, one or both roots can be retained
Classification
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Mobility
Risk factor for PDMeasure extent, determine causeNormal physiologic movement not
gradedDegree of mobility not always
correlated to amount of bone loss
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Causes of Mobility
Mobility may be related to:– Trauma from occlusion– Loss of periodontal support– Gingival inflammation– Pregnancy & hormonal changes– Periodontal surgery
Minor mobility can usually be maintainedIncreasing mobility – more frequent PMT
and/or referral for surery
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Classification of Mobility
Nomenclature used varies across systems:– Class I etc.– Grade I etc.– I mobility etc.– Grade 1 etc.– 1, 2, 3
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Classification of Mobility
– N=normal physiologic mobility– Grade I=slight mobility, up to 1 mm of
horizontal displacement in a facial-lingual direction
– Grade II=moderate mobility, > 1 mm of horizontal displacement
– Grade III=severe mobility, greater than 1 mm of movement in any direction (horizontal & vertical)
• Nield-Gehrig & Houseman, 1996
Mobility can be measured using 2 instrument handles
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Recession
Disturbance to the gingiva results in an apical shift of the gingiva margin
Actual recession:– Level of the epithelial attachment on
tooth
Apparent recession:– Level of the crest of the gingival
margin
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Etiology of Gingival Recession
Causes:– Mechanical
trauma: hard brush, vigorous technique
– Crown margins– Periodontal
disease– Occlusal trauma– Defects in bone
Causes:– Trauma from teeth
in opposing jaw– Oral habits, oral
piercing– Poorly designed
partial dentures– Tooth position– Healing response
following periodontal surgery
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Gingival Recession
Toothbrush Trauma
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Gingival Recession
Trauma from denture
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Gingival Recession
Oral Piercing
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Gingival Recession
Orthodontics
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Gingival Recession
Prominent Roots
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Gingival Recession
Frenal Attachment
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Symptoms/signs
Client usually complains of:– Sensitivity– Aesthetics
Complications:– Increased sensitivity– Loss of tissue from root surface (erosion,
abrasion) – protective cementum removed– Caries– Greater risk for PD: greater surface area for
plaque retention
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Treatment Options
Depends on causeNonsurgical treatment includes:
– Debridement– Oral self-care instruction– Local medicaments for sensitivity
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Treatment Options
Surgical treatment:– Laterally positioned flap– Connective tissue graft